Fractures of the surgical neck of the humerus
Introduction
Introduction to surgical neck fracture of the humerus Humerus surgical path (Humerussurgicalneckfracture) The surgical neck of the humerus is located 2 to 3 cm below the anatomical neck, above the pectoralis major, where the transition from cancellous bone to dense bone is slightly thin, which is an anatomical weak link. All ages can occur, the elderly are more, the surgical neck fracture of the humerus is more severely displaced, and local bleeding is more, especially attention should be paid. basic knowledge The proportion of illness: 2% (high births among young adults and the elderly) Susceptible people: good for the elderly Mode of infection: non-infectious Complications: vascular injury brachial plexus injury radial nerve injury rib fracture blood chest pneumothorax
Cause
Causes of surgical neck fracture of the humerus
Direct violence (10%)
Direct violence on the lateral side of the shoulder can also cause fractures. Shoulder trauma is more likely to occur in shoulder dislocation, less fracture of the upper end of the humerus, unless severe trauma can cause severe fracture of the upper humerus. In childhood, the upper humerus epiphysis is anatomically The weakest part, so the trauma is easy to cause the upper end of the humerus to separate the epiphysis, less joint dislocation, in the middle-aged and elderly patients, the upper end of the humerus becomes loose and the bone strength is greatly weakened, so the slight external force can cause the external tibial fracture of the humerus. .
Indirect violence (60%)
The upper part of the normal humerus is composed of denser reticular cancellous trabeculae, which is stronger than the joint capsule and ligament. Therefore, it is indirectly violent during the young and middle-aged period. If the hand or elbow touches the ground during the fall, the violence conducts the impact along the humeral shaft. Causes a fracture.
Prevention
Prevention of surgical neck fracture of the humerus
The disease is caused by traumatic factors, no effective preventive measures, pay attention to production and life safety, and avoid injury is the key to prevent this disease. Some patients can avoid fractures, which requires everyone to be safe in daily life and work. - Attention can reduce fractures at all times, children are unstable, easy to fall, especially in high places, education And optimistic about children, to avoid falls, teenagers play more, curiosity, parents and teachers should do a good job in education, do not climb the tree, young and middle-aged people should concentrate on work and cycling, pay attention to safety everywhere Old people's hands and feet are inconvenient to move, snow and rain and nights try not to go out. When going out, someone needs to support or hold a cane. When going out at night, there must be lighting tools. It is best not to ride a bicycle on the street, not to crowded public places.
Complication
Complications of surgical neck fracture of the humerus Complications, vascular injury, brachial plexus injury, radial nerve injury, rib fracture, hemothorax
Vascular injury: proximal humeral fracture combined with vascular injury is rare, generally the highest incidence of radial artery injury, and some reported that the rate of injury in displaced fractures is 4.9%, mostly due to high energy injury fracture displacement, old age Due to the hardening of the blood vessels, the patient's blood vessel wall is less elastic and is more susceptible to vascular injury. After the arterial injury, an expansive hematoma is formed locally, the pain is obvious, the limbs are pale or cyanotic, and the skin feels abnormal. In some cases, due to the collateral circulation, there is still blood supply at the extremities. Arteriography can determine the location and nature of the vascular injury, confirming the diagnosis. Surgical exploration should be performed as soon as possible to fix the fracture and repair the damaged blood vessels. It is feasible to transplant the saphenous vein or artificial blood vessel.
Brachial plexus injury: The incidence of proximal humerus fracture with brachial plexus injury is 6.1%, and some reports are as high as 21% to 36%. The most common involvement of the sacral nerve is the scapular nerve, musculocutaneous nerve and radial nerve injury. Occurrence, sacral nerve injury, shoulder lateral skin sensation loss, but the measurement of deltoid fiber contraction is more accurate and reliable, when the sacral nerve injury, EMG can be used to observe the recovery process of nerve injury, the vast majority of cases in 4 months The internal recovery function, if there is no sign of recovery 2 to 3 months after the injury, the nerve exploration can be performed early.
Chest injury: high energy caused by proximal humeral fractures, often combined with multiple injuries, should pay attention to the exception of rib fractures, hemothorax, pneumothorax.
Symptom
Symptoms of surgical neck fracture of the humerus Common symptoms Elbow pain elbow joint can not flex the elbow joint deformity adductive fracture abduction fracture
Similar to other shoulder fractures, but the symptoms are more serious.
1. Swelling is caused by the fracture outside the joint, and the local swelling is more obvious, especially for the adductor type and the crush type.
2. Except for the type of pain, it is more obvious, especially when it is active, accompanied by ring tenderness and pain.
3. After the activity is limited, the second type is the most serious.
4. Others pay attention to the symptoms of neurovascular compression, and the dislocations may be shortened and angular deformed.
Examine
Examination of the surgical neck fracture of the humerus
X-ray examination of the shoulder can confirm the diagnosis: the diagnosis of the surgical neck fracture of the humerus is easy. According to the shoulder X-ray, the type of abduction fracture or adduction fracture can be displayed. There must also be a lateral slice (wearing the chest) to see if the humeral head is rotated, inserted, and overlapped before and after the displacement to determine whether the fracture end is angled forward. It can be divided into three types: adduction or abduction, extension and flexion.
Diagnosis
Diagnosis and diagnosis of surgical neck fracture of humerus
Differential diagnosis
1, surgical neck fracture
Shoulder shape - normal.
Breast test - negative.
The position of the humeral head - normal.
2, shoulder joint dislocation:
Shoulder shape - square shoulder.
Breast test - positive.
The humeral head position - shift.
